Imaging and Therapeutic Method Using Monocytes

ABSTRACT

The invention relates to a method of treating or diagnosing a disease state mediated by monocytes. The method utilizes a composition comprising a conjugate or complex of the general formula 
       A b -X 
     wherein the group A b  comprises a ligand that binds to monocytes, and when the conjugate is being used for treatment of the disease state, the group X comprises an immunogen, a cytotoxin, or a compound capable of altering monocyte function, and when the conjugate is being used for diagnosing the disease state, the group X comprises an imaging agent.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority under 35 U.S.C. § 119(e) to U.S. Provisional Application Ser. No. 60/696,740, filed on Jul. 5, 2005, and to U.S. Provisional Application Ser. No. 60/801,636, filed on May 18, 2006, each incorporated by reference herein in its entirety.

FIELD OF THE INVENTION

This invention relates to methods for treating and diagnosing disease states mediated by monocytes. More particularly, ligands that bind to monocytes are complexed with an imaging agent for use in diagnosis or to an immunogen, a cytotoxin, or an agent for altering monocyte function for use in the treatment of monocyte-mediated disease.

BACKGROUND

The mammalian immune system provides a means for the recognition and elimination of foreign pathogens. While the immune system normally provides a line of defense against foreign pathogens, there are many instances where the immune response itself is involved in the progression of disease. Exemplary of diseases caused or worsened by the host's own immune response are autoimmune diseases and other diseases in which the immune response contributes to pathogenesis. For example, macrophages are generally the first cells to encounter foreign pathogens, and accordingly, they play an important role in the immune response, but activated macrophages can also contribute to the pathophysiology of disease in some instances.

The folate receptor is a 38 KD GPI-anchored protein that binds the vitamin folic acid with high affinity (<1 nM). Following receptor binding, rapid endocytosis delivers the vitamin into the cell, where it is unloaded in an endosomal compartment at low pH. Importantly, covalent conjugation of small molecules, proteins, and even liposomes to folic acid does not block the vitamin's ability to bind the folate receptor, and therefore, folate-drug conjugates can readily be delivered to and can enter cells by receptor-mediated endocytosis.

Because most cells use an unrelated reduced folate carrier to acquire the necessary folic acid, expression of the folate receptor is restricted to a few cell types. With the exception of kidney, choroid plexus, and placenta, normal tissues express low or nondetectable levels of the folate receptor. However, many malignant tissues, including ovarian, breast, bronchial, and brain cancers express significantly elevated levels of the receptor. In fact, it is estimated that 95% of all ovarian carcinomas overexpress the folate receptor. It has been reported that the folate receptor β, the nonepithelial isoform of the folate receptor, is expressed on activated (but not resting) synovial macrophages. Thus, folate receptors are expressed on a subset of macrophages (i.e., activated macrophages).

SUMMARY

It is unknown, however, whether folate receptors are expressed on monocytes, the precursor cells for macrophages. Thus, Applicants have undertaken to determine whether folate receptors are expressed on monocytes and whether monocyte targeting, using a ligand such as folate, to deliver cytotoxic or other inhibitory compounds to monocytes, is useful therapeutically. Applicants have also undertaken to determine whether an imaging agent linked to a ligand capable of binding to monocytes may be useful for diagnosing inflammatory pathologies.

A method is provided for treating and diagnosing disease states mediated by monocytes. In one embodiment, the monocytes are activated monocytes. In one embodiment, disease states mediated by monocytes are treated by delivering an immunogen to the monocytes, by linking the immunogen to a ligand that binds to monocytes, to redirect host immune responses to monocytes. In another embodiment, monocytes can be inactivated or killed by other methods such as by the delivery to monocytes of cytotoxins or other compounds capable of altering monocyte function.

In the embodiment where an immunogen is delivered to monocytes to inactivate or kill monocytes, ligands that bind to monocytes are conjugated with an immunogen to redirect host immune responses to the monocytes, or the ligand is conjugated to a cytotoxin for killing of monocytes. Ligands that can be used in the conjugates of the present invention include those that bind to receptors expressed on monocytes (e.g., activated monocytes), such as the folate receptor, or ligands such as monoclonal antibodies directed to cell surface markers expressed on monocytes or other ligands that bind to activated monocytes. In another embodiment, ligands that bind to monocytes are conjugated to an imaging agent and the conjugate is used to diagnose diseases mediated by monocytes.

In another embodiment, a method is provided for diagnosing a disease state mediated by monocytes. The method comprises the steps of isolating monocytes from a patient suffering from a monocyte-mediated disease state, contacting the monocytes with a composition comprising a conjugate or complex of the general formula

A_(b)-X

where the group A_(b) comprises a ligand that binds to monocytes and the group X comprises an imaging agent, and quantifying the percentage of monocytes that expresses a receptor for the ligand. In another embodiment, A_(b) comprises a folate receptor binding ligand. In yet another embodiment, A_(b) comprises a monocyte-binding antibody or antibody fragment or other ligands that bind to activated monocytes. In another embodiment, the imaging agent comprises a metal chelating moiety that binds an element that is a radionuclide. In still another embodiment, the imaging agent comprises a chromophore selected from the group consisting of fluorescein, Oregon Green, rhodamine, phycoerythrin, Texas Red, and AlexaFluor 488.

In another embodiment, a method is provided for diagnosing a disease state mediated by monocytes. The method comprises the steps of administering parenterally to a patient a composition comprising a conjugate or complex of the general formula

A_(b)-X

where the group A_(b) comprises a ligand that binds to monocytes and the group X comprises an imaging agent, and quantifying the percentage of monocytes that expresses a receptor for the ligand.

In another embodiment, a method is provided for treating a disease state mediated by monocytes. The method comprises the steps of administering to a patient suffering from a monocyte-mediated disease state an effective amount of a composition comprising a conjugate or complex of the general formula

A_(b)-X

where the group A_(b) comprises a ligand that binds to monocytes and the group X comprises an immunogen, a cytotoxin, or a compound capable of altering monocyte function, and eliminating the monocyte-mediated disease state.

In yet another embodiment, a compound for diagnosing or treating a disease state mediated by monocytes is provided. The compound is selected from the following group of compounds:

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows folate-fluorescein binding to human monocytes isolated from peripheral blood and left untreated or preincubated with a 100-fold excess of unlabeled folic acid to compete with folate-fluorescein for binding.

FIG. 2 shows folate-fluorescein (folate-FITC e.g. folate-fluorescein isothiocyanate) binding, quantified by flow cytometry, to CD11b⁺ human monocytes (panel A) and to CD11b⁺ human monocytes preincubated with an excess of unlabeled folic acid (panel B) to compete with folate-FITC for binding.

FIG. 3 shows flow cytometry analysis, using CD11b (A), CD14 (B), CD16 (C), CD69 (D), and HLA-DR (E) antibodies, of CD markers that are co-expressed with the folate receptor on human monocytes.

FIG. 4 shows binding of ³H-folic acid to white blood cells from humans, dogs, rabbits, rats, mice, or to KB cells. The cells were either preincubated with a 100-fold excess of unlabeled folic acid (cross-hatched bars labeled with an “xs”) or not preincubated with excess unlabeled folic acid (solid bars).

FIG. 5 shows folate-FITC binding, analyzed by flow cytometry, to peripheral blood monocytes from dogs (panels A and C) and horses (panels B and D) and competition of binding by unlabeled folic acid.

FIG. 6 shows folate-FITC (A-C) or folate-AlexaFluor 488 (D-F) binding, analyzed by flow cytometry, to peripheral blood monocytes from dogs and competition of binding by unlabeled folic acid.

FIG. 7 shows folate-phycoerythrin binding, analyzed by flow cytometry, to human peripheral blood monocytes and competition by unlabeled folic acid.

FIG. 8 shows the percentage of human peripheral blood monocytes that are folate receptor positive in healthy humans (squares) and in patients with rheumatoid arthritis (diamonds), osteoarthritis (upper group of triangles), and fibromyalgia (three triangles at lowest percentages).

FIG. 9 shows paw volume over time in rats after arthritis induction. The rats were treated with folate-flumethasone (50 nmoles/kg/day; squares) or folate-indomethacin (100 (triangles) or 250 (diamonds) nmoles/kg/day) or were untreated (circles).

FIG. 10 shows the percentage of human peripheral blood monocytes that are folate receptor positive in patients with rheumatoid arthritis over the course of therapy.

DETAILED DESCRIPTION

Methods are provided for treating and diagnosing disease states mediated (e.g., caused or augmented) by monocytes. Exemplary disease states include fibromyalgia, rheumatoid arthritis, osteoarthritis, ulcerative colitis, Crohn's disease, psoriasis, osteomyelitis, multiple sclerosis, atherosclerosis, pulmonary fibrosis, sarcoidosis, systemic sclerosis, organ transplant rejection (GVHD), lupus erythematosus, Sjögren's syndrome, glomerulonephritis, inflammations of the skin (e.g., psoriasis), and chronic inflammations. Such disease states can be diagnosed by isolating monocytes (e.g., whole blood or peripheral blood monocytes) from a patient suffering from such disease state, contacting the monocytes with a composition comprising a conjugate of the general formula A_(b)-X wherein the group A_(b) comprises a ligand that binds to monocytes, and the group X comprises an imaging agent, and quantifying the percentage of monocytes expressing a receptor for the ligand.

Such disease states can also be diagnosed by administering parenterally to a patient a composition comprising a conjugate or complex of the general formula A_(b)-X where the group A_(b) comprises a ligand that binds to monocytes and the group X comprises an imaging agent, and quantifying the percentage of monocytes that expresses a receptor for the ligand.

Monocyte-mediated disease states can be treated in accordance with the methods disclosed herein by administering an effective amount of a composition A_(b)-X wherein A_(b) comprises a ligand that binds to monocytes and wherein the group X comprises an immunogen, a cytotoxin, or a compound capable of altering monocyte function. Such monocyte targeting conjugates, when administered to a patient suffering from a monocyte-mediated disease state, work to concentrate and associate the conjugated cytotoxin, immunogen, or compound capable of altering monocyte function with the population of monocytes to kill the monocytes or alter monocyte function. The conjugate is typically administered parenterally, but can be delivered by any suitable method of administration (e.g., orally), as a composition comprising the conjugate and a pharmaceutically acceptable carrier therefor. Conjugate administration is typically continued until symptoms of the disease state are reduced or eliminated, or administration is continued after this time to prevent progression or reappearance of the disease.

As used herein, the terms “eliminated” and “eliminating” in reference to the disease state, mean reducing the symptoms or eliminating the symptoms of the disease state or preventing the progression or the reoccurrence of disease.

As used herein, the terms “elimination” and “deactivation” of the monocyte population that expresses the ligand receptor mean that this monocyte population is killed or is completely or partially inactivated which reduces the monocyte-mediated pathogenesis characteristic of the disease state being treated.

As used herein, “mediated by” in reference to diseases mediated by monocytes means caused by or augmented by. For example, monocytes can directly cause disease or monocytes can augment disease states such as by stimulating other immune cells to secrete factors that mediate disease states, such as by stimulating T-cells to secrete TNF-α. Illustratively, monocytes themselves may also harbor infections and cause disease and infected monocytes may cause other immune cells to secrete factors that cause disease such as TNF-α secretion by T-cells.

In one embodiment, monocyte-mediated disease states are diagnosed in a patient by isolating monocytes from the patient, contacting the monocytes with a conjugate A_(b)-X wherein A_(b) comprises a ligand that binds to monocytes and X comprises an imaging agent, and quantifying the percentage of monocytes expressing the receptor for the ligand. In another embodiment, the imaging or diagnostic conjugates can be administered to the patient as a diagnostic composition comprising a conjugate and a pharmaceutically acceptable carrier and thereafter monocytes can be collected from the patient to quantify the percentage of monocytes expressing the receptor for the ligand A_(b). In this embodiment, the composition is typically formulated for parenteral administration and is administered to the patient in an amount effective to enable imaging of monocytes. In another embodiment, disease states can also be diagnosed by administering parenterally to a patient a composition comprising a conjugate or complex of the general formula A_(b)-X where the group A_(b) comprises a ligand that binds to monocytes and the group X comprises an imaging agent, and quantifying the percentage of monocytes that expresses a receptor for the ligand.

In one embodiment, for example, the imaging agent (e.g., a reporter molecule) can comprise a radiolabeled compound such as a chelating moiety and an element that is a radionuclide, for example a metal cation that is a radionuclide. In another embodiment, the radionuclide is selected from the group consisting of technetium, gallium, indium, and a positron emitting radionuclide (PET imaging agent). In another embodiment, the imaging agent can comprise a chromophore such as, for example, fluorescein, rhodamine, Texas Red, phycoerythrin, Oregon Green, AlexaFluor 488 (Molecular Probes, Eugene, Oreg.), Cy3, Cy5, Cy7, and the like.

Diagnosis typically occurs before treatment. However, in the diagnostic methods described herein, the term “diagnosis” can also mean monitoring of the disease state before, during, or after treatment to determine the progression of the disease state. The monitoring can occur before, during, or after treatment, or combinations thereof, to determine the efficacy of therapy, or to predict future episodes of disease. The imaging can be performed by any suitable imaging method known in the art, such as intravital imaging.

The method disclosed herein can be used for both human clinical medicine and veterinary applications. Thus, the host animal afflicted with the monocyte-mediated disease state and in need of diagnosis or therapy can be a human, or in the case of veterinary applications, can be a laboratory, agricultural, domestic or wild animal. In embodiments where the conjugates are administered to the patient or animal, the conjugates can be administered parenterally to the animal or patient suffering from the disease state, for example, intradermally, subcutaneously, intramuscularly, intraperitoneally, or intravenously. Alternatively, the conjugates can be administered to the animal or patient by other medically useful procedures and effective doses can be administered in standard or prolonged release dosage forms, such as a slow pump. The therapeutic method described herein can be used alone or in combination with other therapeutic methods recognized for the treatment of inflammatory disease states.

In the ligand conjugates of the general formula A_(b)-X, the group A_(b) is a ligand that binds to monocytes (e.g., activated monocytes) when the conjugates are used to diagnose or treat disease states. Any of a wide number of monocyte-binding ligands can be employed. Acceptable ligands include particularly folate receptor binding ligands, and analogs thereof, and antibodies or antibody fragments capable of recognizing and binding to surface moieties expressed or presented on monocytes. In one embodiment, the monocyte-binding ligand is folic acid, a folic acid analog or another folate receptor binding molecule. In another embodiment the monocyte-binding ligand is a specific monoclonal or polyclonal antibody or an Fab or an scFv (i.e., a single chain variable region) fragment of an antibody capable of binding to monocytes.

In one embodiment, the monocyte-binding ligand can be folic acid, a folic acid analog, or another folate receptor-binding molecule. Analogs of folate that can be used include folinic acid, pteropolyglutamic acid, and folate receptor-binding pteridines such as tetrahydropterins, dihydrofolates, tetrahydrofolates, and their deaza and dideaza analogs. The terms “deaza” and “dideaza” analogs refers to the art recognized analogs having a carbon atom substituted for one or two nitrogen atoms in the naturally occurring folic acid structure. For example, the deaza analogs include the 1-deaza, 3-deaza, 5-deaza, 8-deaza, and 10-deaza analogs. The dideaza analogs include, for example, 1,5 dideaza, 5,10-dideaza, 8,10-dideaza, and 5,8-dideaza analogs. The foregoing folic acid analogs are conventionally termed “folates,” reflecting their capacity to bind to folate receptors. Other folate receptor-binding analogs include aminopterin, amethopterin (methotrexate), N¹⁰-methylfolate, 2-deamino-hydroxyfolate, deaza analogs such as 1-deazamethopterin or 3-deazamethopterin, and 3′,5′-dichloro-4-amino-4-deoxy-N¹⁰-methylpteroylglutamic acid (dichloromethotrexate).

In another embodiment, other vitamins can be used as the monocyte-binding ligand. The vitamins that can be used in accordance with the methods described herein include niacin, pantothenic acid, folic acid, riboflavin, thiamine, biotin, vitamin B₁₂, vitamins A, D, E and K, other related vitamin molecules, analogs and derivatives thereof, and combinations thereof.

In other embodiments, the monocyte-binding ligand can be any ligand that binds to a receptor expressed or overexpressed on activated monocytes including CD40-, CD16-, CD14-, CD11b-, and CD62-binding ligands, 5-hydroxytryptamine, macrophage inflammatory protein 1-α, MIP-2, receptor activator of nuclear factor kB ligand antagonists, monocyte chemotactic protein 1-binding ligands, chemokine receptor 5-binding ligands, RANTES-binding ligands, chemokine receptor-binding ligands, and the like.

The monocyte (e.g., activated monocytes) targeted conjugates used for diagnosing or treating disease states mediated by monocytes have the formula A_(b)-X, wherein A_(b) is a ligand capable of binding to monocytes, and the group X comprises an imaging agent or an immunogen, cytotoxin, or a compound capable of altering monocyte function. In such conjugates wherein the group A_(b) is folic acid, a folic acid analog, or another folic acid receptor binding ligand, these conjugates are described in detail in U.S. Pat. No. 5,688,488, the specification of which is incorporated herein by reference. That patent, as well as related U.S. Pat. Nos. 5,416,016 and 5,108,921, and related U.S. Patent Application Publication No. 2005/0002942 A1, each incorporated herein by reference, describe methods and examples for preparing conjugates useful in accordance with the methods described herein. The present monocyte-targeted imaging and therapeutic agents can be prepared and used following general protocols described in those earlier patents and patent applications, and by the protocols described herein.

In accordance with another embodiment, there is provided a method of treating disease states mediated by monocytes by administering to a patient suffering from such disease state an effective amount of a composition comprising a conjugate of the general formula A_(b)-X wherein A_(b) is as defined above and the group X comprises a cytotoxin, an immunogen, or a compound capable of altering monocyte function. In these embodiments, the monocytes can be activated monocytes and the group A_(b) can be any of the ligands described above. Exemplary of cytotoxic moieties useful for forming conjugates for use in accordance with the methods described herein are clodronate, anthrax, Pseudomonas exotoxin, typically modified so that these cytotoxic moieties do not bind to normal cells, and other toxins or cytotoxic agents including art-recognized chemotherapeutic agents such as adrenocorticoids, alkylating agents, antiandrogens, antiestrogens, androgens, estrogens, antimetabolites such as cytosine arabinoside, purine analogs, pyrimidine analogs, and methotrexate, busulfan, carboplatin, chlorambucil, cisplatin and other platinum compounds, tamoxiphen, taxol, cyclophosphamide, plant alkaloids, prednisone, hydroxyurea, teniposide, and bleomycin, nitrogen mustards, nitrosureas, vincristine, vinblastine, MEK kinase inhibitors, MAP kinase pathway inhibitors, PI-3-kinase inhibitors, mitochondrial perturbants, NFκB pathway inhibitors, proteosome inhibitors, pro-apoptotic agents, glucocorticoids, such as prednisolone, flumethasone, dexamethasone, and betamethasone, indomethacin, diclofenac, proteins such as pokeweed, saporin, momordin, and gelonin, non-steroidal anti-inflammatory drugs (NSAIDs), protein synthesis inhibitors, didemnin B, verrucarin A, geldanamycin, and the like. Such toxins or cytotoxic compounds can be directly conjugated to the monocyte-binding ligand, for example, folate or another folate receptor-binding ligand, or they can be formulated in liposomes or other small particles which themselves are targeted as conjugates of the monocyte-binding ligand typically by covalent linkages to component phospholipids.

Similarly, when the group X comprises a compound capable of altering a monocyte function, for example, a cytokine such as IL-10 or IL-11, the compound can be covalently linked to the targeting ligand A_(b), for example, a folate receptor-binding ligand or a monocyte-binding antibody or antibody fragment directly, or the monocyte function altering compound can be encapsulated in a liposome which is itself targeted to monocytes by pendent monocyte targeting ligands A_(b) covalently linked to one or more liposome components.

In another embodiment, conjugates A_(b)-X where X is an immunogen or a compound capable of altering monocyte function, can be administered in combination with a cytotoxic compound. The cytotoxic compounds listed above are among the compounds suitable for this purpose.

In another method of treatment embodiment, the group X in the monocyte targeted conjugate A_(b)-X, comprises an immunogen, the ligand-immunogen conjugates being effective to “label” the population of monocytes responsible for disease pathogenesis in the patient suffering from the disease for specific elimination by an endogenous immune response or by co-administered antibodies. The use of ligand-immunogen conjugates in the method of treatment described herein works to enhance an immune response-mediated elimination of the monocyte population that expresses the ligand receptor. Such elimination can be effected through an endogenous immune response or by a passive immune response effected by co-administered antibodies.

The methods of treatment involving the use of ligand-immunogen conjugates are described in U.S. Patent Application Publication Nos. U.S. 2001/0031252 A1 and U.S. 2002/0192157 A1, and PCT Publication No. WO 2004/100983, each incorporated herein by reference.

The endogenous immune response can include a humoral response, a cell-mediated immune response, and any other immune response endogenous to the host animal, including complement-mediated cell lysis, antibody-dependent cell-mediated cytotoxicity (ADCC), antibody opsonization leading to phagocytosis, clustering of receptors upon antibody binding resulting in signaling of apoptosis, antiproliferation, or differentiation, and direct immune cell recognition of the delivered immunogen (e.g., an antigen or a hapten). It is also contemplated that the endogenous immune response may employ the secretion of cytokines that regulate such processes as the multiplication and migration of immune cells. The endogenous immune response may include the participation of such immune cell types as B cells, T cells, including helper and cytotoxic T cells, macrophages, natural killer cells, neutrophils, LAK cells, and the like.

The humoral response can be a response induced by such processes as normally scheduled vaccination, or active immunization with a natural antigen or an unnatural antigen or hapten, e.g., fluorescein isothiocyanate (FITC), with the unnatural antigen inducing a novel immunity. Active immunization involves multiple injections of the unnatural antigen or hapten scheduled outside of a normal vaccination regimen to induce the novel immunity. The humoral response may also result from an innate immunity where the host animal has a natural preexisting immunity, such as an immunity to α-galactosyl groups.

Alternatively, a passive immunity may be established by administering antibodies to the host animal such as natural antibodies collected from serum or monoclonal antibodies that may or may not be genetically engineered antibodies, including humanized antibodies. The utilization of a particular amount of an antibody reagent to develop a passive immunity, and the use of a ligand-immunogen conjugate wherein the passively administered antibodies are directed to the immunogen, would provide the advantage of a standard set of reagents to be used in cases where a patient's preexisting antibody titer to potential antigens is not therapeutically useful. The passively administered antibodies may be “co-administered” with the ligand-immunogen conjugate, and co-administration is defined as administration of antibodies at a time prior to, at the same time as, or at a time following administration of the ligand-immunogen conjugate.

The preexisting antibodies, induced antibodies, or passively administered antibodies will be redirected to the monocytes by preferential binding of the ligand-immunogen conjugates to the monocyte cell populations, and such pathogenic cells are killed by complement-mediated lysis, ADCC, antibody-dependent phagocytosis, or antibody clustering of receptors. The cytotoxic process may also involve other types of immune responses, such as cell-mediated immunity.

Acceptable immunogens for use in preparing the conjugates used in the method of treatment described herein are immunogens that are capable of eliciting antibody production in a host animal or that have previously elicited antibody production in a host animal, resulting in a preexisting immunity, or that constitute part of the innate immune system. Alternatively, antibodies directed against the immunogen may be administered to the host animal to establish a passive immunity. Suitable immunogens for use in the invention include antigens or antigenic peptides against which a preexisting immunity has developed via normally scheduled vaccinations or prior natural exposure to such agents such as polio virus, tetanus, typhus, rubella, measles, mumps, pertussis, tuberculosis and influenza antigens, and α-galactosyl groups. In such cases, the ligand-immunogen conjugates will be used to redirect a previously acquired humoral or cellular immunity to a population of monocytes in the host animal for elimination of the monocytes.

Other suitable immunogens include antigens or antigenic peptides to which the host animal has developed a novel immunity through immunization against an unnatural antigen or hapten, for example, fluorescein isothiocyanate (FITC) or dinitrophenyl, and antigens against which an innate immunity exists, for example, super antigens and muramyl dipeptide.

The monocyte-binding ligands and immunogens, cytotoxic agents, compounds capable of altering monocyte function, or imaging agents, as the case may be in forming conjugates for use in accordance with the methods described herein can be conjugated by using any art-recognized method for forming a complex. This can include covalent, ionic, or hydrogen bonding of the ligand to the immunogen, either directly or indirectly via a linking group such as a divalent linker. The conjugate is typically formed by covalent bonding of the ligand to the targeted entity through the formation of amide, ester or imino bonds between acid, aldehyde, hydroxy, amino, or hydrazo groups on the respective components of the complex or, for example, by the formation of disulfide bonds. Methods of linking monocyte-binding ligands to immunogens, cytotoxic agents, compounds capable of altering monocyte function, or imaging agents are described in U.S. Patent Application Publication No. 2005/0002942 A1 and PCT Publication No. WO 2006/012527, each incorporated herein by reference.

Alternatively, as mentioned above, the ligand complex can be one comprising a liposome wherein the targeted entity (that is, the imaging agent, or the immunogen, cytotoxic agent or monocyte function-altering agent) is contained within a liposome which is itself covalently linked to the monocyte-binding ligand. Other nanoparticles, dendrimers, derivatizable polymers or copolymers that can be linked to therapeutic or imaging agents useful in the treatment and diagnosis of monocyte-mediated diseases can also be used in targeted conjugates.

In one embodiment of the invention the ligand is folic acid, an analog of folic acid, or any other folate receptor binding molecule, and the folate ligand is conjugated to the targeted entity by a procedure that utilizes trifluoroacetic anhydride to prepare γ-esters of folic acid via a pteroyl azide intermediate. This procedure results in the synthesis of a folate ligand, conjugated to the targeted entity only through the γ-carboxy group of the glutamic acid groups of folate. Alternatively, folic acid analogs can be coupled through the α-carboxy moiety of the glutamic acid group or both the α and γ carboxylic acid entities.

The therapeutic methods described herein can be used to slow the progress of disease completely or partially. Alternatively, the therapeutic methods described herein can eliminate or prevent reoccurrence of the disease state.

The conjugates used in accordance with the methods described herein of the formula A_(b)-X are used in one aspect to formulate therapeutic or diagnostic compositions, for administration to a patient, wherein the compositions comprise effective amounts of the conjugate and an acceptable carrier therefor. Typically such compositions are formulated for parenteral use. The amount of the conjugate effective for use in accordance with the methods described herein depends on many parameters, including the nature of the disease being treated or diagnosed, the molecular weight of the conjugate, its route of administration and its tissue distribution, and the possibility of co-usage of other therapeutic or diagnostic agents. The effective amount to be administered to a patient is typically based on body surface area, patient weight and physician assessment of patient condition. An effective amount can range from about to 1 ng/kg to about 1 mg/kg, more typically from about 1 μg/kg to about 500 μg/kg, and most typically from about 1 μg/kg to about 100 μg/kg.

Any effective regimen for administering the ligand conjugates can be used. For example, the ligand conjugates can be administered as single doses, or they can be divided and administered as a multiple-dose daily regimen. Further, a staggered regimen, for example, one to three days per week can be used as an alternative to daily treatment, and such an intermittent or staggered daily regimen is considered to be equivalent to every day treatment and within the scope of this disclosure. In one embodiment, the patient is treated with multiple injections of the ligand conjugate wherein the targeted entity is an immunogen or a cytotoxic agent or a compound capable of altering monocyte function to eliminate the population of pathogenic monocytes. In one embodiment, the patient is treated, for example, injected multiple times with the ligand conjugate at, for example, 12-72 hour intervals or at 48-72 hour intervals. Additional injections of the ligand conjugate can be administered to the patient at intervals of days or months after the initial injections, and the additional injections prevent recurrence of disease. Alternatively, the ligand conjugates may be administered prophylactically to prevent the occurrence of disease in patients known to be disposed to development of monocyte-mediated disease states. In one embodiment, more than one type of ligand conjugate can be used, for example, the host animal may be pre-immunized with fluorescein isothiocyanate and dinitrophenyl and subsequently treated with fluorescein isothiocyanate and dinitrophenyl linked to the same or different monocyte targeting ligands in a co-dosing protocol.

The ligand conjugates are administered in one aspect parenterally and most typically by intraperitoneal injections, subcutaneous injections, intramuscular injections, intravenous injections, intradermal injections, or intrathecal injections. The ligand conjugates can also be delivered to a patient using an osmotic pump. Examples of parenteral dosage forms include aqueous solutions of the conjugate, for example, a solution in isotonic saline, 5% glucose or other well-known pharmaceutically acceptable liquid carriers such as alcohols, glycols, esters and amides. The parenteral compositions for use in accordance with this invention can be in the form of a reconstitutable lyophilizate comprising the one or more doses of the ligand conjugate. In another aspect, the ligand conjugates can be formulated as one of any of a number of prolonged release dosage forms known in the art such as, for example, the biodegradable carbohydrate matrices described in U.S. Pat. Nos. 4,713,249; 5,266,333; and 5,417,982, the disclosures of which are incorporated herein by reference. The ligand conjugates can also be administered topically such as in an ointment or a lotion, for example, for treatment of inflammations of the skin.

In any of the embodiments discussed above, the monocytes can be activated monocytes or other monocyte populations that cause disease states. The following examples are illustrative embodiments only and are not intended to be limiting.

Example 1 Materials

Fmoc-protected amino acid derivatives, trityl-protected cysteine 2-chlorotrityl resin (H-Cys(Trt)-2-ClTrt resin #04-12-2811), Fmoc-lysine(4-methyltrityl) wang resin, 2-(1H-benzotriaxol-1-yl)-1,1,3,3-tetramethyluronium hexafluorophosphage (HBTU) and N-hydroxybenzotriazole were purchased from Novabiochem (La Jolla, Calif.). N¹⁰-trifluoroacetylpteroic acid was purchased from Sigma, St. Louis, Mo. All anti-mouse and anti-human antibodies were purchased from Caltag Laboratories, Burlingame, Calif. Folate-R-Phycoerytherin, Folate-Alexa Fluor 488, Folate-Texas Red, and Folate-Fluorescein and Folate-cysteine were synthesized as described. Tritium (³H)-labeled folic acid was obtained from American Radiolabeled Chemicals (St. Louis, Mo.).

Example 2 Synthesis of Folate-Cysteine

Standard Fmoc peptide chemistry was used to synthesize folate-cysteine with the cysteine attached to the γ-COOH of folic acid. The sequence Cys-Glu-Pteroic acid (Folate-Cys) was constructed by Fmoc chemistry with HBTU and N-hydroxybenzotriazole as the activating agents along with diisopropyethylamine as the base and 20% piperidine in dimethylformamide (DMF) for deprotection of the Fmoc groups. An α-t-Boc-protected N-α-Fmoc-L-glutamic acid was linked to a trityl-protected Cys linked to a 2-Chlorotrityl resin. N¹⁰-trifluoroacetylpteroic acid was then attached to the γ-COOH of Glu. The Folate-Cys was cleaved from the resin using a 92.5% trifluoroacetic acid-2.5% water-2.5% triisopropylsilane-2.5% ethanedithio solution. Diethyl ether was used to precipitate the product, and the precipitant was collected by centrifugation. The product was washed twice with diethyl ether and dried under vacuum overnight. To remove the N¹⁰-trifluoracetyl protecting group, the product was dissolved in a 10% ammonium hydroxide solution and stirred for 30 min at room temperature. The solution was kept under a stream of nitrogen the entire time in order to prevent the cysteine from forming disulfides. After 30 minutes, hydrochloric acid was added to the solution until the compound precipitated. The product was collected by centrifugation and lyophilized. The product was analyzed and confirmed by mass spectroscopic analysis (MW 544, M⁺545).

Example 3 Synthesis of Folate-Cys-AlexaFluor 488

AlexaFluor 488 C₅-maleimide (Molecular Probes, Eugene, Oreg.) was dissolved in dimethyl sulfoxide (DMSO) (0.5 mg in 50 μl DMSO). A 1.5 molar equivalent (0.57 mg) of Folate-Cys was added to the solution and mixed for 4 hours at room temperature. Folate-Cys-AlexaFluor 488 (Folate-AlexaFluor) was purified by reverse-phase HPLC on a C18 column at a flow rate of 1 ml/min. The mobile phase, consisting of 10 mM NH₄HCO₃ buffer, pH 7.0 (eluent A) and acetonitrile (eluent B), was maintained at a 99:1 A:B ratio for the first minute and then changed to 1:99 A:B in a linear gradient over the next 29 minutes. Folate-Cys-AlexaFluor 488 eluted at 20 minutes. The product was confirmed by mass spectroscopy and the biologic activity was confirmed by fluorescence measurement of its binding to cell surface folate receptors on folate receptor positive M109 cells in culture.

Example 4 Synthesis of Folate-Cys-Texas Red

Texas Red C₂-maleimide (Molecular Probes, Eugene, Oreg.) was dissolved in dimethyl sulfoxide (DMSO) (1 mg in 200 μl DMSO). A 1.4 molar equivalent (1 mg) of Folate-Cys was added to the solution and mixed for 4 hours at room temperature. Folate-Cys-Texas Red (Folate-Texas Red) was purified by reverse-phase HPLC on a C18 column at a flow rate of 1 ml/min. The mobile phase, consisting of 10 mM NH₄HCO₃ buffer, pH 7.0 (eluent A) and acetonitrile (eluent B), was maintained at a 99:1 A:B ratio for the first five minutes and then changed to 70:30 A:B in a linear gradient over the next 30 minutes followed by a 1:99 A:B linear gradient over the last 15 minutes. Folate-Cys-Texas Red eluted as two isomer peaks at 44.5 and 45.8 minutes. The product was confirmed by mass spectroscopy and the biologic activity was confirmed by fluorescence measurement of its binding to cell surface folate receptors on folate receptor positive M109 cells in culture.

Example 5 Synthesis of Folate-Oregon Green 514

Standard Fmoc peptide chemistry was used to synthesize a folate peptide linked to Oregon Green (Molecular Probes, Eugene, Oreg.) attached to the γ-COOH of folic acid. The sequence Lys-Glu-Pteroic acid (Folate-Cys) was constructed by Fmoc chemistry with HBTU and N-hydroxybenzotriazole as the activating agents along with diisopropyethylamine as the base and 20% piperidine in dimethylformamide (DMF) for deprotection of the Fmoc groups. An α-t-Boc-protected N-α-Fmoc-L-glutamic acid followed by a N¹⁰-trifluoroacetylpteroic acid was linked to a Fmoc-protected lysine wang resin containing a 4-methyltrityl protecting group on the ε-amine. The methoxytrityl protecting group on the ε-amine of lysine was removed with 1% trifluoroacetic acid in dichloromethane to allow attachment of Oregon Green (Folate-Oregon Green). A 1.5 molar equivalent of Oregon Green carboxylic acid, succinimidyl ester was reacted overnight with the peptide and then washed thoroughly from the peptide resin beads. The Folate-Oregon Green was then cleaved from the resin with a 95% trifluoroacetic acid-2.5% water-2.5% triisopropylsilane solution. Diethyl ether was used to precipitate the product, and the precipitant was collected by centrifugation. The product was washed twice with diethyl ether and dried under vacuum overnight. To remove the N¹⁰-trifluoroacetyl protecting group, the product was dissolved in a 10% ammonium hydroxide solution and stirred for 30 min at room temperature. The product was precipitated with combined isopropanol and ether, and the precipitant was collected by centrifugation.

Example 6 Synthesis of Folate-R-Phycoerythrin

Folate-phycoerythrin was synthesized by following a procedure published by Kennedy M. D. et al. in Pharmaceutical Research, Vol. 20(5); 2003. Briefly, a 10-fold excess of folate-cysteine was added to a solution of R-phycoerythrin pyridyldisulfide (Sigma, St. Louis, Mo.) in phosphate buffered saline (PBS), pH 7.4. The solution was allowed to react overnight at 4° C. and the labeled protein (Mr ˜260 kDa) was purified by gel filtration chromatography using a G-15 desalting column. The folate labeling was confirmed by fluorescence microscopy of M109 cells incubated with folate-phycoerythrin in the presence and absence of 100-fold excess of folic acid. After a 1-h incubation and 3 cells washes with PBS, the treated cells were intensely fluorescent, while the sample in the presence of excess folic acid showed little cellular fluorescence.

Example 7 Synthesis of Folate-Fluorescein

Folate-FITC was synthesized as described by Kennedy, M. D. et al. in Pharmaceutical Research, Vol. 20(5); 2003.

Example 8 Synthesis of Folate-D-R-D-D-C-Prednisolone

Standard Fmoc peptide chemistry was used to synthesize folate-aspartate-arginine-aspartate-aspartate-cysteine (Folate-Asp-Arg-Asp-Asp-Cys, Folate-D-R-D-D-C) with the amino acid spacer attached to the γ-COOH of folic acid. The sequence Cys-Asp-Asp-Arg-Asp-Glu-Pteroic acid (Folate-Asp-Arg-Asp-Asp-Cys) was constructed by Fmoc chemistry with HBTU and N-hydroxybenzotriazole as the activating agents along with diisopropyethylamine as the base and 20% piperidine in dimethylformamide (DMF) for deprotection of the Fmoc groups. Fmoc-D-Asp(OtBu)-OH was linked to a trityl-protected Cys linked to a 2-Chlorotrityl resin. A second Fmoc-D-Asp(OtBu)-OH followed by Fmoc-Arg(Pbf)-OH, Fmoc-D-Asp(OtBu)-OH and Fmoc-Glu-OtBu were added successively to the resin. N¹⁰-trifluoroacetylpteroic acid was then attached to the γ-COOH of Glu. The Folate-Asp-Arg-Asp-Asp-Cys was cleaved from the resin using a 92.5% trifluoroacetic acid-2.5% water-2.5% triisopropylsilane-2.5% ethanedithio solution. Diethyl ether was used to precipitate the product, and the precipitant was collected by centrifugation. The product was washed twice with diethyl ether and dried under vacuum overnight. To remove the N¹⁰-trifluoroacetyl protecting group, the product was dissolved in a 10% ammonium hydroxide solution and stirred for 30 min at room temperature. The solution was kept under a stream of nitrogen the entire time in order to prevent the cysteine from forming disulfides. After 30 minutes, hydrochloric acid was added to the solution until the compound precipitated. The product was collected by centrifugation and lyophilized. The product was analyzed and confirmed by mass spectroscopic analysis (MW 1046).

Example 9 Synthesis of Folate-Indomethacin

2-(2-Pyridyldithio)ethanol was synthesized by dissolving 1.5 equivalents of Aldrithiol (Sigma, St. Louis, Mo.) with 6 equivalents of 4-dimethylaminopyridine (DMAP) in dichloromethane (DCM). The solution was purged with nitrogen and 1 equivalent of mercaptoethanol was added dropwise to the Aldrithiol solution over the course of 15 minutes. The reaction proceeded at room temperature for 30 minutes at which time no odor of mercaptoethanol remained. The reaction was diluted 100-fold with DCM and 5 g of activated carbon was added per gram of Aldrithiol. The reaction mixture was filtered and the solvent removed. The mixture was resuspended in 70:30 (Petroleum ether:Ethylacetate (EtOAc)) and purified by flash chromatography on a 60 Å silica gel column. The product was monitored by thin layer chromatography and collected.

Folate-indomethacin was synthesized following a modified method published by Kalgutkar et al. in the Journal of Med. Chem. 2000, 43; 2860-2870 where the anti-inflammatory (indomethacin) was linked through an ester bond with the 2-(2-Pyridyldithio)ethanol. Briefly, 1 equivalent of indomethacin was dissolved in DCM along with 0.08 equivalents DMAP, 1.1 equivalents 2-(2-Pyridyldithio) ethanol and 1.1 equivalents 1,3-dicyclohexyl-carbodiimide. The reaction proceeded at room temperature for 5 hours. The reaction was purified by chromatography on silica gel (EtOAc:hexanes, 20:80). One equivalent of the purified compound was dissolved in DMSO and to it were added 1.5 equivalents of the folate-Asp-Arg-Asp-Asp-Cys peptide. The resulting solution was reacted for 3 hours at room temperature followed by purification using a HPLC reverse-phase C18 column at a flow rate of 1 ml/min. The mobile phase, consisting of 10 mM NH₄HCO₃ buffer, pH 7.0 (eluent A) and acetonitrile (eluent B), was maintained at a 99:1 A:B ratio for the first five minutes and then changed to 70:30 A:B in a linear gradient over the next 30 minutes. The recovered final product was confirmed by mass spectrometry.

Example 10 Synthesis of Folate-Diclofenac

Folate-diclofenac was synthesized by the method described in Example 9 except that diclofenac was used in place of indomethicin. In various embodiments, n=1, 2, or 3, and where n is illustratively 2.

Example 11 Synthesis of Folate-Cys-Prednisolone

The folate glucocorticoid conjugate of prednisolone was prepared as follows. A 1.1 molar equivalent of prednisone was dissolved in tetrahydrofuran (THF). In a separate vial, a 0.7 molar equivalent of dimethylaminopyridine, 1 molar equivalent of tri(hydroxyethyl)amine and 1 molar equivalent of the linker (synthesis described in PCT Publication No. WO 2006/012527, incorporated herein by reference) were dissolved in dichloromethane. An approximately equal volume of both solutions were combined, mixed and reacted at room temperature for 4 hours. The reaction was monitored by thin layer chromatography using 40:10:1 (Dichloromethane:Acetonitrile:Methanol). The product had an R_(f)=0.52. The product was purified on a silica column (Silica 32-63, 60 Å) using the same ratio of solvents. The recovered product was dried in preparation for conjugation to a folate-peptide. The derivatized glucocorticoid was dissolved in DMSO, to which was added a 1.5 molar equivalent of either the folate-cys or folate-Asp-Arg-Asp-Asp-Cys peptide. The resulting solution was reacted for 3 hours at room temperature followed by purification using a HPLC reverse-phase C18 column at a flow rate of 1 ml/min. The mobile phase, consisting of 10 mM NH₄HCO₃ buffer, pH 7.0 (eluent A) and acetonitrile (eluent B), was maintained at a 99:1 A:B ratio for the first minute and then changed to 1:99 A:B in a linear gradient over the next 39 minutes. The folate-glucocorticoid conjugate eluted at approximately 26 minutes. The recovered final product was confirmed by mass spectrometry.

Example 12 Synthesis of Folate-Cys-Dexamethasone

Folate-cys-dexamethasone was synthesized by a procedure similar to that described in Example 11 except that the glucocorticoid was dexamethasone.

Example 13 Synthesis of Folate-Cys-Flumethasone

Folate-cys-flumethasone was synthesized by a procedure similar to that described in Example 11 except that the glucocorticoid was flumethasone.

Example 14 Isolation of Peripheral Blood Mononuclear Cells (PBMC)

An 8-10 ml sample of whole blood was collected in EDTA anticoagulant tubes. PBMCs were isolated from the blood samples using Ficoll-Paque Plus (Amersham Biosciences, Piscataway, N.J.) and by following the manufacture's provided protocol. Briefly, the blood sample was diluted 50:50 with a balanced salt solution (described below). 8 mL of Ficoll-Paque Plus was added to a 50 ml conical centrifuge tube. The diluted blood sample (approximately 16-20 ml) was layered on top of the Ficoll gradient. The sample was centrifuged at 400×g for 30 minutes at room temperature. Following centrifugation, the plasma layer (top clear layer) was removed using a pipette leaving the lymphocyte/monocyte layer undisturbed. The hazy cell layer immediately below the plasma layer was removed, being careful to remove the entire cell interface but a minimum amount of the Ficoll layer. The isolated cells were put into a sterile 50 ml conical centrifuge tube and diluted 3-fold (vol/vol) using the balanced salt solution. The resulting cell solution was gently mixed and centrifuged at 100×g for 10 minutes at room temperature to pellet the cells. The supernatant was removed and the cells were resuspended in folate deficient RPMI 1640 medium supplemented with 10% heat-inactivated FBS, penicillin (100 IU/ml) and streptomycin (100 μg/ml). Cells were seeded in microcentrifuge tubes or microscopy chambers as dictated by the experiment.

Example 15 Balanced Salt Solution Balanced Salt Solution Preparation (as Prepared by Amersham Biosciences)

Solution A Concentration. (g/L) Anhydrous D-glucose 0.1 percent 1.0 CaCl₂ × 2H₂O 5.0 × 10⁻⁵M 0.0074 MgCl₂ × 6H₂O 9.8 × 10⁻⁴M 0.1992 KCl 5.4 × 10⁻³M 0.4026 TRIS 0.145 M 17.565 Dissolve in approximately 950 ml distilled water and add 10 N HCl until pH is 7.6 before adjusting the volume to 1 L.

Solution B Concentration (g/L) NaCl 0.14M 8.19 To prepare the balanced salt solution mix 1 volume Solution A with 9 volumes Solution B.

Example 16 Ligand Binding

All binding experiments were conducted on ice or in a 4° C. cold room unless indicated otherwise. Folate conjugate and ³H-folic acid binding studies were performed by incubating cells with a 100 nM concentration of the indicated folate dye conjugate for 45 minutes. Competition samples were prepared by pre-incubating the appropriate samples with a 100-fold excess concentration of folic acid (10 μM) five minutes prior to adding the folate dye conjugate. An acidic wash to strip cell-surface bound folate conjugates was performed on indicated samples by washing the cell sample with a 150 mM NaCl solution adjusted to pH 3.5 with acetic acid. All antibody labeling was optimized by titration. Optimal labeling was most often achieved with a 1/1000-1/10,000 dilution of the manufacture's stock antibody solution. After cells were labeled with folate dye conjugates and/or antibodies, the samples were washed twice with PBS to remove non-specific binding. Analysis of folate conjugate binding and/or antibody binding was analyzed by confocal microscopy or by flow cytometry (FCS Calibur, BD, Franklin Lakes, N.J.). After washing ³H-folic acid samples to remove non-specific binding, cells were dissolved in 0.25M NaOH and radioactivity was counted on a scintillation counter.

Example 17 Synthesis of Folate Resonance Energy Transfer Reporter

Compound 1 was prepared by following standard Fmoc chemistry on an acid-sensitive trityl resin loaded with Fmoc-L-Cys (Trt)-OH, as described previously (adapted to the shown peptide sequence). The crude compound 1 was purified by HPLC using a VYDAC protein and peptide C18 column. The HPLC-purified 1 was then reacted with tetramethylrhodamine methanethiosulfonate (Molecular Probes, Eugene, Oreg.) in DMSO to afford compound 2, in the presence of diisopropylethylamine (DIPEA). The desired product was isolated from the reaction mixture by preparative HPLC as described above. The final conjugation was performed by mixing excess DIPEA with 2 (in DMSO) followed by addition of BODIPY FL NHS ester (Molecular Probes, Eugene, Oreg.). Compound 3 was then isolated from this reaction mixture by preparative HPLC.

Example 18 Laser Imaging

Fluorescence resonance energy transfer (FRET) imaging of monocytes to determine uptake of folate-linked imaging agents will be carried out using a confocal microscopy. An Olympus IX-70 inverted microscopy (Olympus, USA) equipped with an Olympus FW300 scanning box and an Olympus 60X/1.2 NA water objective will be used to image the cells. Separate excitation lines and emission filters will be used for each fluorochrome (BODIPY FL, 488 nm (excitation) and 520/40 nm (emission); rhodamine, 543 nm (excitation) and 600/70 nm (emission)). Two laser sources with 543 nm (He—Ne) and 488 nm (Argon) wavelength can be used to excite BODIPY FL and rhodamine separately to obtain two color images when needed. Confocal images can be acquired with a size of 512×512 pixels at 2.7 second scan time and images can be processed using FluoView (Olympus) software.

Example 19 Liposome Preparation

Liposomes were prepared following methods by Leamon et al. in Bioconjugate Chemistry 2003, 14, 738-747. Briefly, lipids and cholesterol were purchased from Avanti Polar Lipids (Alabaster, Ala.). Folate-targeted liposomes consisted of 40 mole % cholesterol, either 4 mole % or 6 mole % polyethyleneglycol (Mr ˜2000)-derivatized phosphatidylethanolamine (PEG2000-PE, Nektar Ala., Huntsville, Ala.), either 0.03 mole % or 0.1 mole % folate-cysteine-PEG3400-PE and the remaining mole % was composed of egg phosphatidylcholine. Non-targeted liposomes were prepared identically with the absence of folate-cysteine-PEG3400-PE. Lipids in chloroform were dried to a thin film by rotary evaporation and then rehydrated in PBS containing the drug. Rehydration was accomplished by vigorous vortexing followed by 10 cycles of freezing and thawing. Liposomes were then extruded 10 times through a 50 nm pore size polycarbonate membrane using a high-pressure extruder (Lipex Biomembranes, Vancouver, Canada).

Example 20 Synthesis of Folate-Pokeweed

Pokeweed antiviral protein was purchased from Worthington Biochemical Corporation (Lakewood, N.J.). N-succinimidyl-3-[2-pyridyldithio]propionate (SPDP; Pierce, Rockford, Ill.) was dissolved in dimethylformamide (9.6 mM). While on ice, a 5 fold molar excess of SPDP (˜170 nmoles) was added to the pokeweed solution (1 mg/ml PBS, MW-29,000). The resulting solution was gently mixed and allowed to react for 30 minutes at room temperature. The non-conjugated SPDP was removed using a centrifuge molecular weight concentrator (MWCO 10,000) (Millipore, Billerica, Mass.). The resulting protein solution was resuspended in PBS containing 10 mM EDTA to a final volume of 1 mL. Approximately a 60 fold molar excess of folate-Asp-Arg-Asp-Asp-Cys peptide (2000 nmoles) was added to the protein solution and allowed to react for 1 hour. The non-reacted folate-Asp-Arg-Asp-Asp-Cys peptide was removed using the centrifuge concentrators as previously described. The protein was washed twice by resuspending the protein in PBS and repeating the protein concentration by centrifugation.

Example 21 Synthesis of Folate-Saporin

The protein saporin was purchased from Sigma (St. Louis, Mo.). Folate-saporin was prepared following folate-protein conjugation methods published by Leamon and Low in The Journal of Biological Chemistry 1992, 267(35); 24966-24971. Briefly, folic acid was dissolved in DMSO and incubated with a 5 fold molar excess of 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide for 30 minutes at room temperature. The saporin was dissolved in 100 mM KH₂PO₄, 100 mM boric acid, pH 8.5. A 10-fold molar excess of the “activated” vitamin was added to the protein solution and the labeling reaction was allowed to proceed for 4 hours. Unreacted material was separated from the labeled protein using a Sephadex G-25 column equilibrated in phosphate-buffered saline, pH 7.4.

Example 22 Synthesis of Folate-Momordin and Folate-Gelonin

The proteins momordin and gelonin were purchased from Sigma (St. Louis, Mo.). Folate-cys pyridyldisulfide was prepared by reacting folate-cys with Aldrithiol (Sigma, St. Louis, Mo.). Both proteins were dissolved in 0.1M HEPPS buffer, pH 8.2. A 6-fold molar excess of Trouts reagent (Aldrich St. Louis, Mo.) dissolved in DMSO (16 mM) was added to each protein solution. The solutions were allowed to react for 1 hour at room temperature. Unreacted material was separated from the protein using a Sephadex G-25 column equilibrated in 0.1M phosphate buffer, pH 7.0. Ellmans test for the presence of free thios were positive for both proteins. While the protein solution was on ice, a 5-fold molar excess of folate-cys pyridyldisulfide dissolved in DMSO was added. The resulting solution was warmed up to room temperature and reacted for 30 minutes. Unreacted material was separated from the labeled protein using a Sephadex G-25 column equilibrated in phosphate-buffered saline, pH 7.4.

Example 23 Preparation of Folate-Targeted Clodronate or Prednisolone Phosphate Liposomes

Liposomes were prepared following methods by Leamon et al. in Bioconjugate Chemistry 2003, 14; 738-747. Briefly, lipids and cholesterol were purchased from Avanti Polar Lipids (Alabaster, Ala.). Folate-targeted liposomes consisted of 40 mole % cholesterol, 5 mole % polyethyleneglycol (Mr ˜2000)-derivatized phosphatidylethanolamine (PEG2000-PE, Nektar Ala., Huntsville, Ala.), 0.03 mole % folate-cysteine-PEG3400-PE and 54.97 mole % egg phosphatidylcholine. Lipids in chloroform were dried to a thin film by rotary evaporation and then rehydrated in PBS containing either clodronate (250 mg/ml) or prednisolone phosphate (100 mg/ml). Rehydration was accomplished by vigorous vortexing followed by 10 cycles of freezing and thawing. Liposomes were then extruded 10 times through a 50 nm pore size polycarbonate membrane using a high-pressure extruder (Lipex Biomembranes, Vancouver, Canada). The liposomes were separated from unencapsulated clodronate or prednisolone phosphate by passage through a CL4B size exclusion column (Sigma, St. Louis, Mo.) in PBS. Average particle size was between 70 and 100 nm.

Example 24 Folate-FITC Binding to Human Monocytes

Folate-FITC binding to human monocytes and to human monocytes preincubated with a 100-fold excess of unlabeled folic acid was measured. Peripheral blood monocytes were isolated as described in Examples 14 and 15 and folate-FITC binding and flow cytometry were performed as described in Example 16. As shown in FIG. 1, folate-FITC bound to human peripheral blood monocytes in the absence of unlabeled folic acid and binding was competed in the presence of a 100-fold excess of unlabeled folic acid.

Example 25 Folate-FITC Binding to CD11b⁺ Human Monocytes

Folate-FITC binding to CD11b⁺ human monocytes and to CD11b⁺ human monocytes preincubated with a 100-fold excess of unlabeled folic acid was quantified. Peripheral blood monocytes were isolated as described in Examples 14 and 15 and folate-FITC binding and flow cytometry were performed as described in Example 16. As shown in FIG. 2, folate-FITC bound to 45.9% of human peripheral blood monocytes in the absence of unlabeled folic acid and to 2% of human peripheral blood monocytes in the presence of a 100-fold excess of unlabeled folic acid.

Example 26 Binding to Human Monocytes of Folate-FITC and Antibodies to CD Markers

Folate-FITC binding and binding of antibodies to CD11b, CD14, CD16, CD69, and HLA-DR markers on human monocytes was quantified. Peripheral blood monocytes were isolated as described in Examples 14 and 15 and folate-FITC and antibody binding and flow cytometry were performed as described in Example 16. As shown in FIG. 3, CD11b, CD14, CD16, CD69, and HLA-DR markers are co-expressed with the folate receptor on human peripheral blood monocytes. It has been reported that CD14- and CD16-expressing monocytes are a population of proinflammatory monocytes (Weber et al., J. Leuk. Biol., 67:699-704 (2000) and Ziegler-Heitbrock, J. Leuk. Biol., 67:603-606 (2000)) suggesting that the folate-receptor-expressing monocytes (about 2% of total circulating white blood cells) are proinflammatory monocytes.

Example 27 Binding of ³H-Folic Acid to White Blood Cells

³H-Folic acid binding to white blood cells was quantified as described in Example 16. White blood cells were preincubated with a 100-fold excess of unlabeled folic acid for the samples labeled “xs.” As shown in FIG. 4, folate receptors are detectable on white blood cells from dogs and mice and on KB cells.

Example 28 Folate-FITC Binding to Peripheral Blood Monocytes from Dogs and Horses

Folate-FITC binding to peripheral blood monocytes from dogs and horses was quantified for monocytes preincubated or not preincubated with a 100-fold excess of unlabeled folic acid. Peripheral blood monocytes were isolated as described in Examples 14 and 15 and folate-FITC binding and flow cytometry were performed as described in Example 16. As shown in FIG. 5, folate receptors were detectable on peripheral blood monocytes of both dogs and horses.

Example 29 Folate-FITC or Folate-AlexaFluor 488 Binding to Peripheral Blood Monocytes from Dogs

Folate-FITC binding or folate-AlexaFluor 488 binding to peripheral blood monocytes from dogs was quantified for monocytes preincubated or not preincubated with a 100-fold excess of unlabeled folic acid. Peripheral blood monocytes were isolated as described in Examples 14 and 15 and folate-FITC and folate-AlexaFluor 488 binding and flow cytometry were performed as described in Example 16. As shown in FIG. 6, folate receptors were detectable on peripheral blood monocytes of dogs using either folate-FITC or folate-AlexaFluor 488.

Example 30 Folate-Phycoerythrin Binding to Human Peripheral Blood Monocytes

Folate-phycoerythrin binding to human peripheral blood monocytes was quantified for monocytes preincubated or not preincubated with a 100-fold excess of unlabeled folic acid. Peripheral blood monocytes were isolated as described in Examples 14 and 15 and folate-phycoerythrin binding and flow cytometry were performed as described in Example 16. As shown in FIG. 7, folate receptors were detectable on human peripheral blood monocytes using folate-phycoerythrin.

Example 31 Folate-FITC Binding to Peripheral Blood Monocytes from Healthy Humans and Patients with Arthritis or Fibromyalgia

Folate-FITC binding to peripheral blood monocytes from healthy humans (squares) and from patients with rheumatoid arthritis (diamonds), osteoarthritis (upper group of triangles), and fibromyalgia (three triangles at lowest percentages) was quantified. Peripheral blood monocytes were isolated as described in Examples 14 and 15 and folate-FITC binding and flow cytometry were performed as described in Example 16. As shown in FIG. 8, folate receptors were detectable on peripheral blood monocytes of humans using folate-FITC. In this assay, patients with fibromyalgia appear to have lower percentages of folate-receptor expressing monocytes in peripheral blood than healthy individuals. The difference may be due to differentiation of monocytes into macrophages and to the egress of activated macrophages from the circulation and localization of activated macrophages to sites of inflammation. Regardless of the reason for this difference, the results in FIG. 8 suggest that folate-imaging agent conjugates may be useful in diagnosing monocyte-mediated disease states, and that one such monocyte-mediated disease state may be fibromyalgia.

Example 32 Animal Model of Arthritis

Arthritis was induced in 150-200 g female Lewis rats (Harlan, Indianapolis, Ind.), n=2-5/dose group. Briefly, 0.5 mg of heat-killed Mycoplasma butericum, suspended in mineral oil (5 mg/ml), was injected on day 0 into the left hind foot of rats following anesthesia with ketamine and xylazine. All treated animals developed arthritis, as evidenced by dramatic swelling in the injected paw, progressive swelling in all noninjected limbs due to the systemic progression of arthritis, and radiographic analysis of affected limbs. All rats were maintained on a folate-deficient diet (DYETS, Inc., Bethlehem, Pa.) for 3 weeks prior to administration of therapeutic agents in order to lower serum folate levels to physiologically relevant concentrations. Control rats were also maintained on a folate-deficient diet but were not induced to develop arthritis.

Example 33 Effect of Therapeutic Agents on Adjuvant-Induced Arthritis

The protocol described in Example 32 for arthritis induction was followed. The efficacy of folate-flumethasone (50 nmoles/kg/day) and folate-indomethacin (100 or 250 nmoles/kg/day) against adjuvant-induced arthritis in rats was investigated. Rats were injected intraperitoneally with either saline (control rats) or folate-flumethasone (50 nmoles/kg/day) or folate-indomethacin (100 or 250 nmoles/kg/day) starting at day 4. Calipers were used to measure left foot dimensions on the days indicated in FIG. 9. The sudden increase in swelling of the adjuvant-injected foot is due to influx of neutrophils which have no folate receptors. Consequently, the therapy has no impact on this phase of paw swelling. However, the data in FIG. 9 suggests that after about 7 days folate-flumethasone and folate-indomethacin have potent therapeutic effects in this adjuvant-induced arthritis model by eliminating or inactivating monocytes as a result of binding and internalization by monocytes of folate-flumethasone or folate-indomethacin.

Example 34 Folate-FITC Binding to Peripheral Blood Monocytes from Patients with Arthritis

Folate-FITC binding to peripheral blood monocytes from patients with rheumatoid arthritis was quantified. Peripheral blood monocytes were isolated as described in Examples 14 and 15 and folate-FITC binding and flow cytometry were performed as described in Example 16. As shown in FIG. 10, folate receptors were detectable on peripheral blood monocytes of humans by using folate-FITC. Patient #1 (x-axis shows patient #) was treated with Enbrel/methotrexate, patient #2 was treated with methotrexate, patient #3 was treated with Medrol, patient #4 was treated with Methotrexate/Azulfidine/Plaquenil, Ibuprofen, prednisone, patient #5 was treated with Methotrexate/Azulfidine/Plaquenil, Celebrex, Medrol, patient #6 was treated with Methotrexate/Azulfidine/Plaquenil, Celebrex, prednisone, and patient #7 was treated with Plaquenil, Arava. In this assay, the percentage of folate-receptor expressing monocytes in peripheral blood of patients with arthritis decreased over the course of arthritis therapy. The results in FIG. 10 indicate that folate receptor-expressing monocytes contribute to the pathogenesis of arthritis.

The foregoing exemplified embodiments are intended to be illustrative of the invention described herein, and should not be construed as limiting. It is to be understood that several variations of those embodiments are contemplated, and are intended to be included herein.

Illustratively, in each of Examples 2 through 13, a wide variety of folate analogs and derivatives may be substituted for folate itself in forming the folate linker conjugates. Those analogs and derivatives, or protected forms thereof, may be included in the synthetic protocols described herein. In addition, structural modifications of the linker portion of the conjugates is contemplated herein. For example, a number of amino acid substitutions may be made to the linker portion of the conjugate, including but not limited to naturally occurring amino acids, as well as those available from conventional synthetic methods. In one aspect, beta, gamma, and longer chain amino acids may be used in place of one or more alpha amino acids. In another aspect, the stereochemistry of the chiral centers found in such molecules may be selected to form various mixture of optical purity of the entire molecule, or only of a subset of the chiral centers present. In another aspect, the length of the peptide chain included in the linker may be shortened or lengthened, either by changing the number of amino acids included therein, or by including more or fewer beta, gamma, or longer chain amino acids. In another aspect, the selection of amino acid side chains in the peptide portion may be made to increase or decrease the relative hydrophilicity of the linker portion specifically, or of the overall molecule generally.

Similarly, the length and shape of other chemical fragments of the linkers described herein may be modified. In one aspect, where the linker includes an alkylene chain, such as is found in Examples 3, 4, and 7, the alkylene may be longer or shorter, or may include branched groups, or include a cyclic portion, which may be in line or spiro relative to the alkylene chain. In another aspect, where the linker includes a beta thiol releasable fragment, such as the thioethyloxy bivalent fragment in Examples 8 through 13, it is appreciated that other intervening groups connecting the thiol end to the hydroxy or carbonate end may be used in place of the ethylene bridge, such as but not limited to optionally substituted benzyl groups, where the hydroxy end is connected at the benzyl carbon and the thiol end is connected through the ortho or para phenyl position, and vice versa.

In another illustrative embodiment, structural modifications may be made to the linker to include additional releasable linkers, such as those described in U.S. Patent Application Publication No. 2005/0002942. 

1. A method for diagnosing a disease state mediated by monocytes, said method comprising the steps of: isolating monocytes from a patient suffering from a monocyte mediated disease state; contacting the monocytes with a composition comprising a conjugate or complex of the general formula A_(b)-X where the group A_(b) comprises a ligand that binds to monocytes and the group X comprises an imaging agent; and quantifying the percentage of monocytes that expresses a receptor for the ligand.
 2. The method of claim 1 wherein A_(b) comprises a folate receptor binding ligand.
 3. The method of claim 1 wherein A_(b) comprises a monocyte-binding antibody or antibody fragment.
 4. The method of claim 1 wherein the imaging agent comprises a metal chelating moiety.
 5. The method of claim 4 wherein the imaging agent further comprises a metal cation.
 6. The method of claim 5 wherein the metal cation is a radionuclide.
 7. The method of claim 1 wherein the imaging agent comprises a radionuclide.
 8. The method of claim 7 wherein the radionuclide is selected from the group consisting of technetium, gallium, indium, and a positron emitting radionuclide.
 9. The method of claim 1 wherein the imaging agent comprises a chromophore.
 10. The method of claim 9 wherein the chromophore comprises a compound selected from the group consisting of fluorescein, Oregon Green, rhodamine, phycoerythrin, Texas Red, and AlexaFluor
 488. 11. The method of claim 1 wherein the patient is suffering from a disease state selected from the group consisting of rheumatoid arthritis, osteoarthritis, ulcerative colitis, Crohn's disease, inflammatory lesions, infections of the skin, osteomyelitis, organ transplant rejection, pulmonary fibrosis, sarcoidosis, systemic sclerosis, lupus erythematosus, glomerulonephritis, inflammations of the skin, and any chronic inflammation.
 12. A method for treating a disease state mediated by monocytes, said method comprising the steps of: administering to a patient suffering from a monocyte-mediated disease state an effective amount of a composition comprising a conjugate or complex of the general formula A_(b)-X where the group A_(b) comprises a ligand that binds to monocytes and the group X comprises an immunogen, a cytotoxin, or a compound capable of altering monocyte function; and eliminating the monocyte-mediated disease state.
 13. The method of claim 12 wherein A_(b) comprises a folate receptor binding ligand.
 14. The method of claim 12 wherein A_(b) comprises a monocyte-binding antibody or antibody fragment.
 15. The method of claim 12 wherein the group X comprises an immunogen.
 16. The method of claim 13 wherein the group X comprises an immunogen.
 17. The method of claim 12 wherein the group X comprises a cytotoxin.
 18. The method of claim 17 wherein the group X further comprises a liposome.
 19. The method of claim 13 wherein the group X comprises a cytotoxin.
 20. The method of claim 19 wherein the group X further comprises a liposome. 21.-27. (canceled) 